Provider Demographics
NPI:1124667050
Name:BOU, SOPEEP
Entity type:Individual
Prefix:
First Name:SOPEEP
Middle Name:
Last Name:BOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3150
Mailing Address - Country:US
Mailing Address - Phone:978-473-0122
Mailing Address - Fax:
Practice Address - Street 1:373 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3150
Practice Address - Country:US
Practice Address - Phone:978-473-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor